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BPPV: Recurrences, Self-Treatment, and Youtube

Dr. Danielle Tate, PT, DPT

If you’ve ever experienced vertigo, I can almost guarantee that you perfectly remember the first time it hit. For me, it was an ice water caloric test on my first day of a clinical rotation. However, for most of you who have had the extremely common condition Benign Paroxysmal Positional Vertigo, (the condition where little crystals roll around in your inner ear), it most likely hit you seemingly out of the blue when you first sat up out of bed in the morning, rolled over in your sleep, or when you were skillfully performing that one complicated yoga move in your workout class. One minute you were fine, and the next the room is spinning. Some of you may have even tossed your cookies.

The severity of the sensation of spinning varies from person to person. Dizziness is very much a subjective complaint and difficult to describe at times. For some people, they mistake their symptoms for a stroke or medical emergency. They go to the hospital, sometimes in an ambulance, and they under go a lot of testing to make sure they’re not dying. When everything checks out okay, they get sent home with meclizine. Sometimes, trained staff will perform BPPV positional testing and a maneuver (which is something that is happening more and more thank goodness!). They are then referred to their primary care physician, who then recommends an Ear, Nose, and Throat doctor and/or neurologist.

At this point, a considerable amount of time has gone by, and the patient has incurred health related costs. In the study “Cost-effective management of benign positional vertigo using canalith repositioning” by Li et al, the authors found that the total cost to a patient in the United States to reach a diagnosis and get treatment for their BPPV totaled between $2,009.63 and $2,684.74 per patient3. Their study concluded that because the treatment techniques are a relatively simple procedure, knowing how to perform the maneuvers can greatly reduce the amount of wasted expenses to the patient. Not to mention reduce the extra time patients feel miserable as they wait to reach a diagnosis and treatment.

So, what should you do if you get dizzy? Should you google it? Try a Youtube video? Will the vertigo come back? First, check out my video below. I briefly describe what BPPV is, why it’s important to get properly diagnosed, and what resources are available to you as a patient to find a vestibular specialist.

Here’s the “too long, didn’t watch the video” summary

  • BPPV is a very common condition where tiny crystals become dislodged from a tiny organ in the inner ear and move around in areas where they shouldn’t be.
  • When you change positions, those crystals move around. Picture tiny stones sinking in water or shaking up a snow globe. When they move around, they trigger short bouts of vertigo, or a sensation of movement when you’re not moving, until they settle down.
  • There are multiple places in both inner ears where these crystals can be stuck, so seeking out help from a vestibular specialist can be very important for diagnosis, and one of the quickest ways to feel better.
  • The type of maneuver or treatment used to fix the positional vertigo will depend on where the crystals are dislodged.
  • For a list of specialists near you, go to The Vestibular Disorders Association’s website (www.Vestibular.org), and click on “Finding help and support”, then “Find a vestibular specialist”.
  • Once you’ve been diagnosed, the specialist can educate you on proper treatment techniques, as well as provide you with more information.

One of the first questions I hear after treating someone with BPPV is “Will this happen again?”. The simple answer is yes, most likely. “BPPV is a highly recurrent disorder with a 15% recurrence rate per year and a 50% rate of recurrences within 40 months (4). Since many video clips have been developed and became available on the video-sharing web sites for easy application of CRPs [treatment maneuvers] for each type of BPPV, self-administration of CRPs [treatment maneuvers] has become feasible in treating recurred BPPV if the patients have the information on the type of BPPV they are suffering from. However, the video clips of CRP placed on the web sites have an accuracy of 64% (1).”2

I thought this study was interesting because it highlighted the finding that the accuracy of the maneuvers learned from videos clips online is approximately 64%. This is a pretty big distinction from the reported 80-92% success rate of maneuvers when applied by a skilled clinician.

So, to make a long story a little shorter: Yes, you can “Youtube it” to treat positional vertigo caused by BPPV. However, it is recommended that you first seek out a vestibular specialist to properly diagnose and train you (or a spouse) to properly and safely perform maneuvers at home. This will increase your chances for success, and minimize excessive costs and time experiencing symptoms.

Here's an example of an Epley maneuver that would treat BPPV in the right ear.

References

1. Kerber KA, Burke JF, Skolarus LE, Callaghan BC, Fife TD, Baloh RW, et al. A prescription for the Epley maneuver: www.youtube.com? Neurology (2012) 79:376–80. doi:10.1212/WNL.0b013e3182604533

2. Kim H-J and Kim J-S (2017) The Patterns of Recurrences in Idiopathic Benign Paroxysmal Positional Vertigo and Self-treatment Evaluation. Front. Neurol. 8:690. doi: 10.3389/fneur.2017.00690

3. Li JC, Li CJ, Epley J, Weinberg L. Cost-effective management of benign positional vertigo using canalith repositioning. Otolaryngol Head Neck Surg (2000) 122:334–9. doi:10.1067/mhn.2000.100752

4. Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg (2000) 122:647–52. doi:10.1016/S0194-5998(00)70190-2

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